Decreased Fertility in Women with Cesarean Scar Syndrome Is Associated with Chronic Inflammation in the Uterine Cavity

Nobuta, Yuri; Tsuji, Shunichiro; Kitazawa, Jun; Hanada, Tetsuro; Nakamura, Akiko; Zen, Rika; Amano, Tsukuru; Murakami, Takashi

doi:10.1620/tjem.2022.j082

Cited by 16 publications

(12 citation statements)

References 26 publications

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“…Gulz et al 49 showed that endometriosis was diagnosed during laparoscopic surgery in 22 of 83 patients (27%). In contrast, our recent report demonstrated that endometriosis was detected in 51 (70%) patients with CSDi, although majority of patients were not at a severe stage of endometriosis 62 . Of these patients with endometriosis, 85% had only peritoneal lesions.…”

Section: Decreased Fertility In Women With Csdimentioning

confidence: 63%

“…Microorganisms may be present because of the retention of blood in CSD and contribute to chronic inflammation. Our group demonstrated that the frequency of chronic endometritis in women with CSDi was significantly higher than that in the general infertile population 62 . Additionally, we showed that higher levels of inflammatory cytokines (tumor necrosis factor‐a and interleukin‐1b) in women with CSDi were detected in the uterine cavity compared to women with a history of CS but without symptoms of CSDi.…”

Section: Decreased Fertility In Women With Csdimentioning

confidence: 65%

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Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

Tsuji

Nobuta

Hanada

et al. 2023

Reprod Medicine & Biology

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BackgroundCesarean scar defects (CSD) are caused by cesarean sections and cause various symptoms. Although there has been no previous consensus on the name of this condition for a long time, it has been named cesarean scar disorder (CSDi).MethodsThis review summarizes the definition, prevalence, and etiology of CSD, as well as the pathophysiology and treatment of CSDi. We focused on surgical therapy and examined the effects and procedures of laparoscopy, hysteroscopy, and transvaginal surgery.Main findingsThe definition of CSD was proposed as an anechoic lesion with a depth of at least 2 mm because of the varied prevalence, owing to the lack of consensus. CSD incidence depends on the number of times, procedure, and situation of cesarean sections. Histopathological findings in CSD are fibrosis and adenomyosis, and chronic inflammation in the uterine and pelvic cavities decreases fertility in women with CSDi. Although the surgical procedures are not standardized, laparoscopic, hysteroscopic, and transvaginal surgeries are effective.ConclusionThe cause and pathology of CSDi are becoming clear. However, there is variability in the prevalence and treatment strategies. Therefore, it is necessary to conduct further studies using the same definitions.

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Section: Decreased Fertility In Women With Csdimentioning

confidence: 63%

Section: Decreased Fertility In Women With Csdimentioning

confidence: 65%

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

Tsuji

Nobuta

Hanada

et al. 2023

Reprod Medicine & Biology

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“…In recent years, the relationship between cesarean scar uterus and subsequent secondary infertility has been gradually recognized, but the specific mechanism is not clear [ 20 , 21 ]. Nobuta et al found that a cause of secondary infertility in women with cesarean scar syndrome may be chronic inflammation of the uterine cavity [ 22 ]. We also found that prior induced abortion, mode of termination of the last pregnancy, age at menarche, menstrual cycle, and level of dysmenorrhea had no effect on subsequent pregnancy outcomes.…”

Section: Discussionmentioning

confidence: 99%

Reproductive factors and subsequent pregnancy outcomes in patients with prior pregnancy loss

Yang,

Mu,

Zhang

et al. 2024

BMC Pregnancy Childbirth

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Background At present, individualized interventions can be given to patients with a clear etiology of pregnancy loss to improve the subsequent pregnancy outcomes, but the current reproductive status of the patient cannot be changed. The aim of this study was to investigate the association between female reproductive status and subsequence pregnancy outcome in patients with prior pregnancy loss (PL). Methods A prospective, dynamic population cohort study was carried out at the Second Hospital of Lanzhou University. From September 2019 to February 2022, a total of 1955 women with at least one previous PL were enrolled. Maternal reproductive status and subsequent reproductive outcomes were recorded through an electronic medical record system and follow-up. Logistic regression was used to evaluate the association between reproductive status and the risk of subsequent reproductive outcomes. Results Among all patients, the rates of subsequent infertility, early PL, late PL, and live birth were 20.82%, 24.33%, 1.69% and 50.77% respectively. In logistic regression, we found that age (OR 1.08, 95% CI 1.04–1.13) and previous cesarean delivery history (OR 2.46, 95% CI 1.27–4.76) were risk factors for subsequent infertility in patients with PL. Age (OR 1.06, 95% CI 1.03–1.10), age at first pregnancy (OR 1.06, 95% CI 1.03–1.10), BMI (OR 1.06, 95% CI 1.02–1.11), previous PL numbers (OR 1.18, 95% CI 1.04–1.57) and without pre-pregnancy intervention (OR 1.77, 95% CI 1.35–2.24) were risk factors for non-live birth. Age (OR 1.06, 95% CI 1.03–1.09), age at first pregnancy (OR 1.06, 95% CI 1.02–1.09), BMI (OR 1.07, 95% CI 1.02–1.11), previous PL numbers (OR 1.15, 95% CI 1.02–1.31) and without pre-pregnancy intervention (OR 2.16, 95% CI 1.65–2.84) were risk factors for PL. Conclusions The reproductive status of people with PL is strongly correlated with the outcome of subsequent pregnancies. Active pre-pregnancy intervention can improve the subsequent pregnancy outcome. Trial registration This study was registered in the Chinese Clinical Trial Registry with the registration number of ChiCTR2000039414 (27/10/2020).

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“…Various disorders, including endometrial polyps, intrauterine adhesions, hydrosalpinx, and cesarean scar defects, have been associated with incidence of CE. 27 , 28 , 29 , 30 CE cases with intrauterine abnormalities or a hydrosalpinx are usually treated through surgery without antibiotics. 27 , 28 , 29 In addition, systemic antibiotic treatment for CE with endometrial polyps may decrease clinical pregnancy rates during infertility treatment after surgery.…”

Section: Tests and Treatments For Implantation Failurementioning

confidence: 99%

Management strategies following implantation failure of euploid embryos

Kuroda

2024

Reprod Medicine & Biology

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BackgroundEuploid blastocyst implantation failure may result from embryonic factors undetectable by preimplantation genetic testing for aneuploidy (PGT‐A); however, various nonembryonic factors can also intricately interfere with implantation. This review seeks to clarify evidence‐based testing and treatments for implantation failure after euploid embryo transfer.MethodsWe conducted a review of the literature on implantation failure after euploid embryo transfer or multiple embryo transfer cycles, which mainly included systematic reviews and meta‐analyses.ResultsThe recommended tests for implantation failure include (1) hysteroscopy, (2) endometrial CD138 immunohistochemistry and bacterial culture, (3) serum 25‐hydroxyvitamin D3, and (4) thrombophilia screening. Based on diagnostic findings, the following treatments have been recommended: (1) antibiotics for chronic endometritis, (2) vitamin D replacement, (3) lifestyle modification, and (4) low‐dose aspirin starting from the postimplantation period for thrombophilia. Moreover, frozen–thawed single euploid blastocyst transfer using assisted hatching and hyaluronan‐enriched transfer medium may support embryo implantation.ConclusionTo ensure a successful pregnancy in subsequent embryo transfers, simple, inexpensive, and evidence‐based tests and treatments should be selected.

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Decreased Fertility in Women with Cesarean Scar Syndrome Is Associated with Chronic Inflammation in the Uterine Cavity

Abstract: Decreased fertility in women with cesarean scar syndrome is associated with chronic inflammation in the uterine cavity

Cited by 16 publications

References 26 publications

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

Reproductive factors and subsequent pregnancy outcomes in patients with prior pregnancy loss

Management strategies following implantation failure of euploid embryos

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